Velkova: We are, yes. We engage our communities locally and provide important learning and networking experiences for all kinds of stakeholders – from clinicians, researchers to government, students, entrepreneurs, innovators and hospital management – outside their community in order to see how other countries are managing the digital transformation journey and how to learn from their examples. That is why each year a certain number of international including European delegations travel to the US. This year, we have assembled programmes for four HIMSS delegations: the Nordic, French, Dutch and the DACH delegation – with the highest participation coming from Germany following the adoption of the new Digital Healthcare Act (DVG) new german digital healthcare
HITN: Who can join the DACH delegation and travel to HIMSS20?
Velkova: It is an open call for registration, however, only a limited number of about 40 participants, mostly from decision-making level, can attend the HIMSS20 conference in the US. For this annual highlight, we normally engage directly with groups of specific organisations or those that have a specific interest in participating. On the industry side, anyone can register independently, but on the community side, we work mostly with the ministries of health as well as local and regional authorities. In the case of Germany, a delegation from Berlin, Brandenburg and Saxony – comprised of industry experts, companies and research facilities – will be joining the DACH delegation to pursue their internationalisation efforts and collaborate with US healthcare players.
For those who come, we provide information on the main programme and what to follow according to their core area of interest. We also bring speakers from the US and other countries who share their knowledge and best practices on how they have approached solutions, challenges and implementations in healthcare.
Furthermore, the DACH delegation is also a neutral platform to discuss interregional cooperation between the three German speaking countries Germany, Austria and Switzerland. Thus, when they return we provide an additional follow-up where we engage the broader community to take part in the results of the conference and engage in an open dialogue with additional local and regional stakeholders who have a key role in driving the digital transformation process.
HITN: Which actors in the healthcare system are expected to benefit the most from the new Digital Healthcare Act and why?
Velkova: The way I read it, the new regulation has been set up first and foremost to the benefit of the patient. It adapts the delivery of care to the 21st century patient while making healthcare services more accessible and faster at higher quality due to increased monitoring. The world of mobile health is moving forward, thus doctors will be able to prescribe mobile health applications for both, diagnostics and treatments to German patients.
These digital applications obviously have to be reimbursable for the public health insurer. We must therefore certify and verify their quality in order to confirm their clinical utility, comparable to the FDA in the US. This way we ensure they actually come into use within 12 months’ time. The underlying idea is that they serve as additional tools to make doctors work easier and ultimately use information, collected by the applications, to provide better patient care and make medical decisions on doctors’ side more informed. The Digital Healthcare Act seeks to ensure that healthcare delivered in Germany will be more user-friendly and accessible, it will reduce red tape in the hospital by bringing some care into the convenience of your home, and help to better cope with the overload of patients and the scheduling process, if used in the most efficient way.
HITN: Some parties have expressed concerns about the new legislation. Why is that?
Velkova: The German culture is not as open to digital technologies and data exchange as other digitally developed healthcare markets in Europe. Personally, I find that the Digital Healthcare Act is a great reform which however skipped a couple of steps.
Firstly, we are going into prescribing digital mobile health applications to patients without even having an existing statutory electronic health record in the hospital or in the primary care. The telematics infrastructure and the connected electronic health record are both not set at the moment.
We only have a health e-card as insurance card that primarily collects information for reimbursement purposes. We currently do not have a comprehensive medical record of the patient that would in addition collect patient information from mobile health applications. That is a big gap that has to be bridged.
HITN: What risks, but also challenges do you foresee?
Velkova: My take is that the stagnation as such when it comes to the electronic health record on a statutory level will probably inspire a lot more debate in the future. The self-governing, multi-stakeholder governance structure of the German healthcare system translates into an overregulated system which is slow to change given the difficulty to reach consensus among the many parties involved in the decision-making process.
The biggest challenge I currently see for the law in place will be to fully optimise the implementation of the law and the long-term power that the services from mobile health applications could have.
HITN: What other opportunities do you see in the new German policy beyond patient benefits?
Velkova: Beyond patient empowerment, I would add one more advantage: the big role for the insurers as being the direct supporters of innovation who have to reimburse and provide services to the market. They will be heavily involved in the certification process of those mobile health applications. Ideally, when it comes to innovation, mobile health developers will benefit from having their products used widely and supported by the insurers. Insurers, on the other hand, will have a significantly bigger role in seeing how these technologies can then be leveraged because, as the healthcare system works, each insurer has to come up with the best benefit package for their members.
And by working with mobile health they can also significantly improve mobile health application solutions and become frontrunners in enabling the data exchange so critical to the delivery of personalised care. In addition, if given the opportunity (current laws do not allow this), insurers alongside public health institutes and academia can be at the forefront of initiating the secondary use of data research capabilities in order to leverage preventive care.
In Germany, in particular, we have great opportunities now to scale an amazing amount of data for research, in order to identify early at-risk patients i.e. detect early on that a patient has certain conditions, identify certain risks and actually prevent a condition from happening.
Thus, care becomes more personalised and of higher quality which leads to healthier nation and alleviates, at the same time, the cost for insurers.
HITN: What are the next steps for German health policy?
Velkova: When it comes to requesting consent to have individual’s data uploaded to their personal electronic health record, my take is that we should have an opt-out scenario. Digital storing of medical information for the purposes of better treatment and disease prevention should be common sense. Germany is still far from that unlike Scandinavia or the UK. In the Nordics, for example, health is a public good, they provide it for every patient, thus health data is public as well. In return for receiving health services, more than 90% of patients give their consent to their data flowing back to the research institutions in order to help building a better healthcare system and gain better health services and a better population health management in the future.
This is all the more important for Germany as digital technologies can have a significant effect on the country’s KPI, namely increase life expectancy, enable more outpatient and community care and make healthcare less costly. With over 11% of GDP going into healthcare, Germany is by far the biggest health spender in Europe. National KPIs, however, do not match these high investment levels, whereas evidence points to many European countries doing better by spending less on health. The common denominator among these countries are advanced levels of digitisation and integration of the national health and care systems that keeps care in the community rather than within hospital walls.
With 83 million patient base (16% of the EU population), Germany can be a game changer for European healthcare too. We hope that the opportunity is seized and every person, from patient to clinician, are better informed about the benefit of improved health outcomes by the wider implementation of digital tools in healthcare and unlocking the power of data and innovative technologies. Communication, education and empowerment of the citizen will be the key.
